Psychotherapy research and the benefits and limitations of the scientific method

As a little girl I wanted to be a scientist. While pursuing my more recent goal of becoming a psychotherapist, I read with interest the many benefits that the scientific method provides to psychotherapy. Unlike Garb, Lilienfeld, and & Fowler (2012, p. 139), I do not doubt that intuition can hasten scientific knowledge and I know from reading Damasio (1995) many years ago that logic cannot exist without intuition. Because of the many cognitive biases that therapists, like other humans, are prone to, however, I do agree that an over-reliance on intuition can be detrimental to psychotherapy. As an example, one study showed that therapists who treat phobias are much more effective when using empirically supported treatments than when designing their own treatment plans (Stewart & Chambless, 2012, p. 152). However, I observe two limitations of the scientific method that are relevant to psychotherapy research. 

The first regards the observer effect, discovered in physics, in which the act of observation affects the phenomenon being observed. The allegiance effect, in which the treatment favored by the researcher almost always beats out the competition (Lebow, 2010) seems like a form of the observer effect. Our beliefs always affect our outcomes, thus a third “effect,” the placebo, and its twin, the nocebo (which occurs when negative expectations about a treatment lead to negative outcomes). I disagree with Stewart & Chambless’ conclusion that the case of mesmerism, which was revealed to be entirely placebo, “illustrates the dangers of reliance on uncontrolled observations of practitioners and patients” (2012, p. 152). While there are indeed dangers to reliance on uncontrolled observations, mesmerism to me is an example of the extraordinary healing power of the placebo, which by itself is not dangerous. If I had a disorder, and someone cured it by waving a bunch of harmless and ineffective magnets around me, I would happily accept the cure, even knowing it was done by placebo (and research shows it is possible for me to know something is a placebo and still benefit from it, according to Lipton, 2005, p. 140). I would not want to wait around for something empirically supported to cure me, based on the misguided notion that this was more scientific. Research supports the use of the placebo itself, and as Lipton (2005) and others have pointed out, when the placebo itself is so powerful, we ought to study it more, or at least, as we have already done to some extent, study the related “non-specific factors common to all treatments such as hope, expectation of change and a good relationship with the therapist” (Stewart & Chambless, 2012). 

My second reservation regards ethics in research. I was disturbed to see Stewart and Chambless advocate that psychotherapy research strive to achieve the “rigorous testing” of pharmaceuticals required by the Food and Drug Administration (2012, p. 150), since research by Whitaker (2002) has demonstrated that the FDA is not preventing ineffective and harmful psychiatric drugs from getting onto the market due to sneaky tactics on the part of pharmaceutical companies. The Transparency for Clinical Trials Act is designed to close some of the loopholes that allow dangerous drugs to be approved (Drazen, 2012), although should the act be approved, further repairs to the approval process may also be needed. Psychotherapy should be rigorously tested, to avoid treatments that are harmful or ineffective, but if psychopharmacaology research is our current best practice standard, we are in trouble. 

If we keep in mind the effects of beliefs and ethics (or lack thereof) of those involved in all stages of research, the scientific method can contribute much to the field of psychotherapy. We must always keep learning, however, for as Watters (2011) and others have pointed out, disorders can change across time and culture. 

References 

Damasio, A. (1995). Descartes’ error: Emotion, reason and the human brain. New York: HarperCollins. 

Drazen, J. (2012, August 8). Transparency for clinical trials: the TEST Act. New England Journal of Medicine, 367: 863-864. Retrieved from http://www.nejm.org/doi/full/10.1056/NEJMe1209433

Garb, H., Lilienfeld, S., & Fowler, K. (2012). Psychological assessment and clinical judgment. In Maddux, J. & Winstead, B. (Eds.), Psychopathology: Foundations for a contemporary understanding (3rd ed.), pp. 121-144). New York: Routledge, Taylor & Francis Group. 

Lebow, J. (2010). Big squeeze: No research, no reimbursement. Retrieved from http://moodle.prescott.edu/mod/resource/view.php?id=82016

Lipton, B. (2005). The biology of belief: Unleashing the power of consciousness, matter & miracles. Santa Rosa, CA: Mountain of Love/Elite Books. 

Stewart, R. & Chambless, D. (2012). Psychotherapy research. In Maddux, J. & Winstead, B. (Eds.), Psychopathology: Foundations for a contemporary understanding (3rd ed.), pp. 145-160). New York: Routledge, Taylor & Francis Group. 

Watters, E. (2011, January 2). Interview by W. Hall. Exporting Mental Disorders. Madness Radio. [Audio file]. Retrieved from http://www.madnessradio.net/madness-radio-exporting-mental-disorders-ethan-watters

Whitaker, R. (2002). Mad in America: Bad science, bad medicine, and the enduring mistreatment of the mentally ill. New York: Basic Books.